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Democrats Launch Health Offensive as Senate Leaders Postpone Floor Vote

By Jane Norman, CQ HealthBeat Associate Editor

July 23, 2009 -- Democrats spread out in a health offensive Thursday in the wake of President Obama's health care press conference, as lawmakers revived their attacks on Republican ideas for a health overhaul, decried insurance industry practices, talked up the value of an independent commission to curb Medicare spending and brought in "real people" in to make the case for change.

It likely was a strong taste of what's to come during the long, hot weeks of August. Senate Majority Leader Harry Reid, D-Nev., said that Senate floor action on the overhaul will be delayed until senators return to work after Labor Day. The announcement wasn't much of a surprise, since Majority Whip Richard J. Durbin of Illinois had said the same on Wednesday night and the Senate Finance Committee has continued to meet for hours on end in negotiations aimed at finding a bipartisan compromise.

But it raised questions about how Democrats will continue to make their case with the American public over the summer recess, withstand criticism from Republicans and win over wavering members of their own party—all likely accompanied by a barrage of advertising from all sides in the debate. House Democrats also remained stalled on their march toward floor action by the end of the afternoon.

Reid said that Republicans working with Democrats on Finance had asked for more time, "so the decision was made to give them more time." He said he spoke with Finance Committee Chairman Max Baucus, D-Mont., who said he plans to mark up a bill prior to when the Senate leaves for its recess Aug. 7. It's better to have a product based on "quality and thoughtfulness," said Reid.

Though Democratic leaders for weeks have said they wanted floor debate on the health overhaul before the recess, "all of this is no big surprise," said Reid. He said the Finance Committee and Health, Education, Labor and Pensions Committee bills will be merged during the recess and the legislation will be ready for action when the Senate returns to Washington in September.

Other Democrats also downplayed fears that delay means failure. "The whole goal has always been to have the president sign it by the end of the year," said Sen. Charles Schumer, D-N.Y. "So the plan is going to be out there for a period of time. It's going to have to stand the test of the public as's going to be out there for a significant period of time while the public reacts and maybe the plan is modified."

In Cleveland, at an appearance at the Cleveland Clinic promoting his health care plan, the president said of the Senate delay until fall: "That's OK." Meanwhile, two of his emissaries, Health and Human Services Secretary Kathleen Sebelius and Nancy-Ann DeParle, director of the White House Office of Health Reform, met over a lunch with Senate Democrats. Sebelius emerged to say that the overhaul "isn't about playing beat the clock but there's an urgency to health reform that deals with each and every American's life."

The desire to accommodate Republicans did not extend to the other chamber. Rep. Chris Van Hollen, D-Md., the chairman of the Democratic Congressional Campaign Committee, kicked off the day by slamming Republicans for failing to produce a complete health overhaul plan and for criticism of the cost of the Democrats' plans after the head of the Congressional Budget Office (CBO) said the House bill would do little to contain spending. "The president has made it clear we are going to respond to the issues the Congressional Budget Office raised on the spending side," said Van Hollen.

Separately, House Minority Leader John Boehner, R-Ohio, said Democrats have ignored all GOP ideas. "We outlined our bill over a month ago to the president and to our Democrat colleagues," said Boehner. "And unfortunately, they've taken very little of our ideas and incorporated them in their bill. But I hope—hope remains eternal. I happen to be an optimist, and I do believe at the end of the day if there's going to be a bill signed into law, it's going to have to be done with Democrats and Republicans working together in the best interests of the American people."

Van Hollen brushed aside questions as to whether Democrats are worried about GOP inroads in August. "The more the American people know the details of health care reform, the more they're going to see this is a good deal for the American people," he said.

House Speaker Nancy Pelosi declined to set a firm date for floor action in the House, and a top House Democrat, Majority Whip James E. Clyburn, D-S.C., said the House should not leave town until the bill is approved on the floor. The House is scheduled to begin its recess on July 31, a week before the Senate.

One idea that has continued to percolate in the wake of the CBO criticism is that of an independent commission similar to the Medicare Payment Advisory Commission (MedPAC), only with the power to enact curbs on Medicare spending. Office of Management and Budget Director Peter Orszag in a conference call with reporters said such a commission would "take the politics out of the process" and move Medicare to a more value-based system. The new commission also could tackle the sensitive issue of regional disparities in Medicare spending, he said, one of the issues that the fiscally conservative Blue Dog Democrats are pressing with House leaders.

Also on the revenue front, Sen. Thomas R. Carper, D-Del., a member of the Senate Finance Committee, said he continues to support the idea of taxing a portion of the most generous health insurance plans provided to employees, which has been touted by health care economists. "Is there some level, maybe $25,000 for a family? Most family health insurance is under $15,000," he said. He said Finance members also continue to explore the idea of taxing insurers on expensive plans but there may be problems with self-insured companies.

"It doesn't take but a couple of Republicans or Democrats to torpedo whatever plan we have," added Carper. "We are trying to find a consensus that will get 60 votes out here, on an issue where some of our Republican friends on the far right, they're not interested in solving a problem, they're interested in an issue. And they're putting huge pressure on the three Republicans—Sen. Grassley, Sen. Snowe and Sen. Enzi—not to be a part of this negotiation. Huge pressure." Republican Conference Chairman Lamar Alexander of Tennessee has denied that Republicans don't want these members—Finance Committee Republicans Charles E. Grassley, Olympia J. Snowe and Michael B. Enzi — negotiating.

Democrats sought to keep the focus on the need for a health care system that not only costs less but serves consumers better. Sen. Patty Murray, D-Wash., said she asked for stories from constituents about their problems with insurance and received 5,000 letters in return. "We know most Americans like their doctors, like their coverage today, think they have good insurance, and they're happy until payday," she said. "On payday they see more and more of their paycheck being taken away by increasing insurance premiums."

Thursday's health offensive also found members of the Congressional Black Caucus talking about health care and House Majority Leader Steny H. Hoyer, D-Md., bringing families to a press conference who had been denied insurance coverage because of pre-existing conditions. Reid's own press event featured a breast cancer survivor and a widow whose husband died at the age of 39 after years without insurance or regular preventive care. The White House had turned to new media, advertising a Facebook chat with DeParle, but it was postponed.

Through it all, Democrats maintained that they are ready to take their case to the people in August and can complete work on the overhaul. "I think we're on track," said Schumer. "No one wants delay but I think the president has done this just right. He keeps importuning us and moving us and pushing us forward, but not to the extent you don't have the best product possible."

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